I've read it a hundred times on here, but still stunned!!!

[jaybee72]

Like the title says I have read many times on here how little info is given to the patients, but I'm still stunned after experiencing it!

Summary:

At yearly physical I told my doctor that my wife says I stop breathing and make choking noises while sleeping. He says I'll order a sleep study.

1 week later I do a baseline sleep study.

1 day later The doctor's office nurse calls, gets my wife, and says he has apnea; we are going to order a titration. Period

I call nurse back and she seems surprised that I want actual data, but since she doesen't know what she's reading she doesn't give much info.

1 week from first sleep study I do the titration. The tech there was nice and gave me a few of the numbers from the first study.

1 week later my doctor's office calls and talks to my wife again. She says they are faxing the order for the cpap to a DME who should be in contact today. period

I called the nurse back and she told it was all taken care of, the dme would be in contact soon.

I was really too stunned to ask logical questions at that point. I told her I was expecting there to be a follow-up visit with my doctor to go over the results and talk about the options, etc. Nope. She said the dme would go over the operation of the cpap and if things didn't go well the first month I could see the doctor. She seemed surprised when I started to ask her for information from the study results!!

So, I asked her what dme she sent the prescription to, and she named off one I hadn't heard of. She said it was the only one on her list that my BCBS covered. But, she said it was thier favorite, and they had great patient feedback on them. We'll see...

I have been in contact with the insurance company, and they confirmed I am covered 100% on DME. They also told me that there are no compliance requirements on my policy, but they recommend renting a machine for a while before buying. They did tell me my policy mandated I use contracting DME's; that buying it myself and submitting for reimbursement was not possible.

Since I have only a month and a half to go with this policy before going to a new company I am going to see how this DME works out. I'm going to tell them up front that my insurance will be going away soon, and if they aren't willing to do a quick purchase they won't have any of my business.

Wow - I just can't believe how strange this industry is...

[Wulfman...]

Like the title says I have read many times on here how little info is given to the patients, but I'm still stunned after experiencing it!

Summary:

At yearly physical I told my doctor that my wife says I stop breathing and make choking noises while sleeping. He says I'll order a sleep study.

1 week later I do a baseline sleep study.

1 day later The doctor's office nurse calls, gets my wife, and says he has apnea; we are going to order a titration. Period

I call nurse back and she seems surprised that I want actual data, but since she doesen't know what she's reading she doesn't give much info.

1 week from first sleep study I do the titration. The tech there was nice and gave me a few of the numbers from the first study.

1 week later my doctor's office calls and talks to my wife again. She says they are faxing the order for the cpap to a DME who should be in contact today. period

I called the nurse back and she told it was all taken care of, the dme would be in contact soon.

I was really too stunned to ask logical questions at that point. I told her I was expecting there to be a follow-up visit with my doctor to go over the results and talk about the options, etc. Nope. She said the dme would go over the operation of the cpap and if things didn't go well the first month I could see the doctor. She seemed surprised when I started to ask her for information from the study results!!

So, I asked her what dme she sent the prescription to, and she named off one I hadn't heard of. She said it was the only one on her list that my BCBS covered. But, she said it was thier favorite, and they had great patient feedback on them. We'll see...

I have been in contact with the insurance company, and they confirmed I am covered 100% on DME. They also told me that there are no compliance requirements on my policy, but they recommend renting a machine for a while before buying. They did tell me my policy mandated I use contracting DME's; that buying it myself and submitting for reimbursement was not possible.

Since I have only a month and a half to go with this policy before going to a new company I am going to see how this DME works out. I'm going to tell them up front that my insurance will be going away soon, and if they aren't willing to do a quick purchase they won't have any of my business.

Wow - I just can't believe how strange this industry is...

That first one I highlighted would make me nervous.

However, since you're covered 100%, I don't see any reason you shouldn't get the top-of-the-line Auto. (w/A-Flex)

And here you were worried in that other thread about the meeting with the doctor.....

Den

[Snoredog]

be warned if you enter into an agreement with one insurance then switch at the first of the year you might as well start over, if that first DME is not on your new insurance list you will be stuck with the bill on your own, be careful signing any agreements.

[Sergey45]

Wow - I just can't believe how strange this industry is...

_________________

Well, at the beginning I had same feeling of total helplessness. But after some time you are just starting to understand that it will be no help from sleep doctor/lab and from DME as well. So it will be better for you if you start learning all the treatment process and will take care of things.

[Iskander]

I was in a similar situation... presented with a list of DMEs and told to just pick one. I declined. The sleep center I went to didn't really understand why, although when I explained, they were fine with giving me my prescription and PSG (this morning). Later, I called billmyinsurance.com, and found out that I couldn't get an APAP with the prescription I was given, and I would never be able to reorder. It turned out that going to cpap.com (which they suggested as an alternative) allowed me to get the equipment I want, with the self-monitoring abilities that I demand (plus or minus software that I have no ethical problem getting from bittorrent), and they'll deliver it tomorrow... all for a couple of hundred bucks more. I'm very conscious that I'm very fortunate to be able to pay that premium to own my own equipment and have appropriate control over my own treatment, and that not everyone is as fortunate, but frankly, I would pay the full $840 (incl. overnight shipping) for just one week of good sleep at this point.

It took was some research here, and a polite insistence on my rights, and I was able to overcome my longstanding submission to medical "machines". Quite an empowering morning. One of the staff at the sleep center actually asked me to let him know what my experience with cpap.com was like - I'll be happy to. If it helps more people get better treatment, faster and cheaper, I'm all for it.

The more of us that stand up for our rights, and make sites like this well-known and viable competition to the predatory DMEs, the more likely we are to be able to effect change in this corrupt and unethical system.

[jasper]

That's unacceptable... time to get a new doctor. You should be able to sit down and go over the results in detail, and then come away with a copy of the full study. Nothing less will do. On the other hand I'm amazed at the turnaround times, from diagnosis to PSG to titration. I had to wait months to get in, and then many weeks between the PSG and the titration. Good thing it's not a serious diagnosis. Oh, wait a minute... it is! (AHI 65). Thankfully we have this forum to keep us informed and well directed.

[goose]

My comments are about the same as Jasper's....
I can't believe how quickly you got taken care of -- I was told I needed a sleep test in November 2006, got my first sleep test in Feb. '07, got my titration in late March '07 and didn't get my machine until June 5th.......

But that doc leaves a lot to be desired. I have a great doc and a reasonably decent DME, but when I want to talk about my treatment she's all ears and if I make a treatment suggestion, she's willing to let me try.....

good luck!!! Keep us up on how it's going.....
cheers
goose

[RosemaryB]

If you are saying that you need to get a machine now and your current insurance will cover 100% of it without a rental period, it sounds like you should certainly get it now. But, I'd also check with billmyinsurance.com to see if they accept the insurance you have. They are very easy to deal with and will be honest and upfront with you, from what I hear.

If the only place you can get it is the one your doctor contacted, make sure you get the machine you want. You may have to call the doctor and have him write the script for the exact machine you want. That seems to work for most.

I agree with Snoredog. Be very careful about what you sign. These places lie like rugs, so don't take a verbal explanation of what it says from them.

[guest84]

I am also new to cpap. Just received machine (F & P 434, I think) Friday.

I have to agree that the medical profession makes things difficult.
My family Dr. sent me for the sleep study w/titration. Saying "Someone will call with results in 7-10days. On the 11 day I called them just to find out that they had perscribed a cpap and which dme would I like to use. No talk of any results.

I told them just to send the perscription and the results to my house, I then made an appointment with a neuroligist who actually explained every thing really well and set me up with a good dme (so far).

All the regular dr would have had to do was a referral, but I guess that was to hard.


All in all it took over a month from sleep test to machine.

[jaybee72]

I should probably clarify that the doctor that ordered the sleep study is actually a great doctor, and I wouldn't think of leaving him. He is usually extremely thorough and very attentive. There is a long waiting list of people wanting to be his patients. But, I guess this experience has proven that he is not a sleep doctor...

Yes, my insurance company told me today that they pay 100% on cpap equipment and my particular plan does not require a compliance period. They only require that I use a DME that they contract with. So, my plan is to try and get the machine up front now. I did not hear from the DME today, but definitely will call them tomorrow if they don't beat me to it. My doctor's office says they have great feedback from them. It appears that it is a small one location company, so I'm keeping my mind open about them.

I plan to tell this DME the insurance situation and explain to them they can either get me the machine I want or I will go elsewhere. I am not concerned about getting an apap, but will not settle for a cpap that doesn't record full data and have exhale relief.

I have actually been stunned by how fast this has all transpired! But, my doctor does tend to push stuff through. And, it doesn't hurt that my designated hospital (and that's where the sleep study was) is one of Emory's. We have had great experiences with this hospital, and actually drive past 2 closer pnes to get to it!



Thanks for all the info!

[RosemaryB]

It's great that you have a good doctor. I have one who is quite good, too. My doctor wrote a script for the exact machine I wanted. Right now I'm working to help a family member who has OSA and contacted the DME in her area and they said they could get the machine with a Dr's prescription. They also want a second one to get her the mask she wants, since it's one they don't normally carry.

It may be that the DME is a good one. I have a locally owned company. They balked at the auto, but I eventually got it. They were good at letting me try a number of masks when I went for my fitting. I told them which ones and they had most of them. (I researched them here first). This is a great advantage if you can find a reasonably good DME. I plan to try a few more masks when my insurance will pay for a new mask.